How to prepare for delivery and what to expect during labour

An expert obstetrician-gynaecologist tells you how to prepare for delivery of your baby and what happens once you enter a Mediclinic labour ward.

Draw up a birth plan

Once you know you’re pregnant, you’ll have a few months to plan what kind of delivery you prefer. Being prepared for labour and delivery can go a long way towards reducing anxiety and stress and making the experience more pleasant for everyone.

A birth plan is a written outline of what you would like to happen during labour and delivery. Discuss and share it with your healthcare professionals and your partner, so they’re aware of your preferences. But be aware that births don’t always go according to plan – babies don’t always arrive on schedule or how you had expected. It’s always best to have a plan in place but to accept that you may have to be flexible.

“I encourage couples to have a delivery plan and to attend antenatal classes during their pregnancy because, while you can never be truly prepared for labour and every birth is different, it helps to know what to expect,” says Dr Mpume Zenda, an obstetrician-gynaecologist and sexologist at Mediclinic Morningside. Pain management is a key issue to consider in your birth plan, she adds. Your obstetrician will discuss the various options available for a natural birth and for a caesarean.

What can I include in my birth plan?

Your birth plan can specify:

• who your birth partner will be
• where you want to give birth and how
• if you want pain management and if so, what kind
• what music you want to listen to
• what you’d like to happen to the placenta after birth
• any religious/cultural customs you want adhered to.

Be financially prepared

“A very important aspect of a delivery is being financially prepared. While Mediclinic’s Private Fixed Fees product means we have standard costs for those patients paying privately, sometimes things don’t go as expected and a natural birth may become an emergency caesarean,” Dr Zenda cautions. “We encourage couples to take out medical aid beforehand so they’re able to afford, for example, an epidural (local anaesthetic that numbs the lower half of the body) if necessary. Even if you plan not to take pain medication, this may change during labour, which can take 24 hours or more.” Be aware that some medical aid schemes will not cover you for the birth if you’re already pregnant when you join as a new member. If you don’t have cover, it’s always best to sign up before you fall pregnant.

The critical role of partner support

Your partner must feel included in the delivery process, because they can be an important source of emotional and physical support during labour. At Mediclinic, partners are encouraged to be in the delivery room as their presence often helps put the labouring woman at ease.

“One of the key questions I’m often asked by partners is: ‘What can I do?’ The most vital action they can take is to inform themselves beforehand about what to expect, and to be present,” says Dr Zenda. “For religious, cultural, or other personal reasons, some partners may not want to be in the delivery room or may find it too traumatic. I encourage them to be there, to stay with their partners and support them, even if they avoid watching the actual birth from the doctor’s perspective. The most important thing is that the couple is on the same page.”

What to pack for the hospital

Mediclinic has a useful checklist of what to take to hospital for the delivery and post-delivery. This includes practical items for mother and baby, including the necessary clothing, nappies, and toiletries, as well as comfort items for the mom, such as massage oil, comfortable clothing, games, and reading matter.

“Certain non-medical items can make the delivery more pleasant for the woman in labour and play a big role in helping her cope with the experience psychologically,” says Dr Zenda. “At Mediclinic, our labour rooms are comfortable and inviting. Since each client has their own labour room, they can bring items from home to make them feel more comfortable and emotionally settled, because labour may take 8-24 hours or more. Music can go a long way to making a labouring woman feel calmer and more able to cope.”

How do I know if I’m in labour?

Labour can begin in various ways and parents-to-be should know what to expect so as not to get anxious during the birth. It may start with contractions, your water may rupture, or you may get a “show” – a sticky mucous plug that is released from the cervix. If any of these occur, this is when you must check in to the hospital, says Dr Zenda.

Always contact your medical aid to obtain pre-authorisation for the delivery as this simplifies the admission process. The alternative is to investigate our streamlined Private Fixed Fees if you’re paying privately. You can then be whisked straight through to the delivery room and won’t waste time at reception filling in forms, which can be distracting when labour has begun.

After the nurses have conducted a brief assessment, we will contact your doctor/obstetrician-gynaecologist and discuss pain management. Nursing staff will monitor your baby’s heartbeat and your contractions using cardiotocography (CTG) soon after you check in. Your doctor will monitor your and your baby’s progress every four hours during the early, latent stages of labour, when your cervix softens and starts to dilate. They’ll do vaginal examinations to see if the cervix has dilated sufficiently for the baby’s head to come through. If the CTG is abnormal, this is a red flag that shows the baby is in distress. In such a case, critical action may be necessary, such as an emergency caesarean.

Active labour

“When the contractions are back-to-back, you’re in active labour and even women who were set on a natural birth without pain medication may change their mind at this stage,” says Dr Zenda. “Discussing all these options with your doctor or gynaecologist beforehand can reduce anxiety.”

Other than your doctor/obstetrician-gynaecologist, you can expect a midwife, a paediatrician, and an anaesthetist to be present at the birth. Sometimes a nurse may also be present. Your doctor would normally deliver the baby, unless they can’t get there in time. In this event, the midwife will assist with a natural birth. If any complications arise, the doctor may use devices to speed up the birth, such as forceps. This prevents the baby’s head from receding back into the birth canal after each push.

“An injury to be aware of during labour is the tearing of the perineal region,” Dr Zenda adds. If the vaginal opening is too tight, your doctor may decide to do an episiotomy. This is a surgical incision on the side of the vagina that enlarges the opening. It also prevents a more serious tear occurring from the vagina to the anus.

Mediclinic’s labour rooms are private so clients can take videos or photos during the labour – but discuss this beforehand with your medical professional. Once the baby is born, depending on your birth plan wishes and the doctor’s advice, you may want to breastfeed straight away. This is a wonderful way to bond with your little one. We also actively encourage kangaroo care once your baby is born. If there are no issues, you’ll be encouraged to breastfeed and do skin-to-skin care. If you’re unable to do immediate skin to skin care, e.g., you require stitches, your partner may do this until you’re able to take the baby.

Dr Zenda says she derives great satisfaction from her specialty of obstetrics: “I get to walk the journey of new life with couples, almost like a big sister, watching their ‘jellybean’ of a foetus grow into a human being. I love being instrumental in bringing new people to the world, and I realise how much it means to the parents to have a doctor who is invested in the process and gives them leeway with their delivery.”

To find an obstetrician-gynaecologist near you, visit www.mediclinic.co.za